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BP2002-884Type Insp'n MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date <-3 Time /W7 Permit No. B Ac 2 ' ig y Name Address 379 /jig J'OS Company _ 30f 57.3 - 33 8P Phone # For Inspector: ;/6 _D„2 Name & D Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date a ' /--6 - a2i Time Type Insp'n / i 4t I ?.V}7f- 1 - 11 07 Permit No. ot?" s:gy Name (Lf. Address 377 4iG /eas y Company Phone # 305 373 - For Inspector:3 ;76 . Name & D Approved Correction ❑ Re-Insp'n Fee ❑ Date Legal Description 11 Historically Designated: Yes -��No %)e, Owner/Lessee / Tenant G WS al Master Permit # P ' J a ' ?PF Owners Address 379 E lCD Phone 305— — 7 5 1 - 155/ Contracting Co. 5 � (Th a0 0,..)s Mark R 1 p - ort state # (-to' t3So0 Municipal # Qualifier PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 3 ME 100 \ • Tax Folio Address 5 a ©5 N l) .7 fl L) • SS# Phone ' 5- 5(3-13i2 Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): UILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION t'11 +0.t LP Ca- se-rnq_ rat wi,„ (SO W Square Ft. g Q ( .1-- Estimated Cost (value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. >ILI/02 20416_12 ticiPRL lg Signature of owner and/or Condo President Date Notary as er and/or Co IKCo President My Comm sio Expires: NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC828525 1•,!Y COMMISSION EXP. APR. 21 003 FEES: PERMIT tl c $ t.ADON C.C.F3 "Qo NOTARY ■ O""'1 BO APPROVED: Zoning Mechanical Date No My 61 /72 Electrical Building Contract o er- Builder Date Contractor or er- Builder nunission E4pire 9h,'./ ; i NC`fA13Y PUBLIC SEAT 2 O:F FLO:IIDA COMMISSION NO. CCO2.1525 TOTAL DUE Date Plumbing Structural Engineer ALLSTATE ,DOWS • DOORS • SHUTTERS NAME: G k 010 I ADDRESS: 3 7 / N r ( 00 51 CITY: ( l S 1 O O STATE: I � - ZIP: 3 3 3 1 b cs i 5 -4:T DIAGRAM ©�� • � �v�� 2 �� ��an -7S� ��ItQ o3 • 11 - ) I�z�l - S V2 — 1 f hd (I w lid IJ1 (arf e t-1551) - ac S, h. = SI() y lt- Hi4 8$�/ -cI e L �0 jilt-hers {r 0 Id N-t 't n � two ✓e CONTRACT DATE: CONTRACT NUMBER: SALESMAN: Toe_ INSTALLER: DATE OF INSTALLATION: HOME PHONE: 30 OFFICE PHONE: 0 Non - Impact 7 LOOKING: OUTSIDE/IN — FRONT OF HOUSE Manufacturer: P " T Impact 7S/— 7S57 MASONERY: Inside Plaster Outside Stucco Operators SILLS: Marble B/N Cer5mic R/H FINISH: Anod. BRONZE ✓ White Esp. UH Block up Sq. Ft. Bin Blk 4 IN. Blk DIRECTIONS: WHITE - OFFICE /YELLOW - CUSTOMER / PINK - SALESMAN / 2002— CUSTOME SIGNATURE Type Window In: GSD RES. DOOR QTHER Cmt. `// Horz Full Store Alum STYLE: ATW(SV) SH COL. GSD P.W.F. View Front Door 2/2 OX 2d2t 3/16 1/1 XO 4d2t 1/4 H.R.S.O. ✓ COL. XOX 3d3t H.L.S.O. Glass Type: Clear Brz. S/C ✓Grey t 6 A OBS INSUL. Temp. Lexan: Laminated: ►// rviIAMtoADE gard I CONTROL NOTICE OF ACCE1'"t':ti.NCE J'(;'1' industries 1070 '1'cchnOIorY 1)1• yr Nokomis ,FL 34275 r Notice of Aecelirrtnt cnt \\'indo\\• impact de of Nlittini-Dad The expense of such testing, \Vi11 be incurred by the manufacturer. ACCEPTANCE `O.: 01-1108.07 1 \ Ijl I S: 01/28/2007 ;APPROVE]): 12/2712001 \\s \templates \notice acceptance over page.dot Internet mail address: po stmaster .rraildingetl(leonliue.conl JAIL ;0' I- 1)AM'. COUNTY, FLORIDA Ai1.TRO -DAUL FLAGLI:R BUILDING 11(')1.1)1NG CO)): CO\Irr.):1,\('I UPPI('t: !l: rRo- I); \1)F. FLAW ! :1: Ill :II.1))Nti I•nJ \ \'Iiti I' ):1 {1( ti•'1(l:li'!. SIB : I(4); \11: \, \!I. F .UI(1)):\ 33!)1.1:(,3 (3 )5) .175.29o) )' : \\ 13(15) 315. 2')111 ('().`;'11(.\( "1'OIt 1.1(1:.\ I. \(: Si( : . 1 . ! ON (3111) 17.2■27 CAN (!(*) (•O. \•lI(:\ ( - rOI( FN'101(( :I {.tit \ "I' 1)1\'1,10.\ 01)3)375-206f, FAN (3115) .175.:4(1 :( 11101)1(I '('O..\iit ()1.I)I \'ISIU \' (305) )73.2402 I :AX 1J' ,172•0119 Your application 1 OA) 01: Aluminum Ca1Cll under Chapter 8 of IL. Minty uoverning the use ol'Alternate Nlaterials:eldTypes of Construction, and completely 1 est_ It.( lerein, has been recommended for acceptance by the ,Miami -Dade County Iluildint4 Code Compliance Office (13CCO) under the conditions specified herein, This NOt\ shall not be valid after the expiration date stated below. 13000 reser,'es the rit ht to secure this product or material at any time from a jobsite or manufacturer's plant for quality control tcstilt�.;. II' this product or material fails to perform in the approved manner. 13CCO may revoke, modify, or suspend the use of such product or material immediately. BCC() reserves the right to revoke this approval. if it is dctcrmincd by 13CC° that this product or material [ails to meet the requircm_nts Of the South Florida 13uildin�, Code. Raul Rctiriguez Chid' Product Control Division THIS IS TIIE COVERSE[EIET, SEE AE)I)ITION:tL, PAGES F{)R SPECIFIC AND GENERAL. CONDITIONS BUILDING CODE & PRODUCT RF,V[E \V C \1,1IITTEI: - I'llis application for Product Approval has been reviewed by the i3CCO and approved by the Building Code and Product Review Committee to be used in Nliami -Dade Count', Floridc: under the conditions set fords above. Fran ise. J. Quintana. It..\. Director ianli -Dade County 13uilcling Code Compliance 01lice I ome )age: Ilttp:// N' 14H'.l)1111d(ngeodeunllne.e'on1 PCT Industries. ACCEPTANCE No.: 01 1108.07 APPROVED: December 27, 2001 EXPIRES: January 28, 2007 NOTICE OF ACCEPTANCE: SPECIFIC CONDITIONS L SCOPE 1.1 This revises and renews Notice of Acceptance (NOA) No. 00 0804.03, which was issued on December 7, 2000. 11 revises and renews the approval of an aluminum casement window, as described in Section 2 of this NOA, designed to comply with the South Florida Building Code (SFBC), 1994 Edition for Miami -Dade County, fir the locations where the pressure requirements, as determined by SFI3C Chapter 23, do not exceed the Design Pressure Rating values indicated in the approved drawings. 2. PRODUCT DESCRIPTION 2.1 The Series "C -700" Outswing Aluminum Casement Window — Impact Resistant and its components shall be constructed in strict compliance with the following document: Drawing No 339, Sheets 1 through 5 of 5, titled "Aluminum Casement lmp2ct Window," prepared by manufacturer, dated 2/13/98 and revised on 11 /6/01, signed and sealed by Robert L. Clark, P.E., bearing the Miami -Dade County Product Control approval stamp with the NOA number and approval date by the Miami -Dade County Product Control Division. This document shall hereinafter be referred to as the approved drawings. 3. LIMITATIONS 3.1 This approval applies to single unit applications only, as shown in approved drawings. 4. INSTALLATION 4,1 The aluminum casement window and its components shall be installed in strict compliance with the approved drawings. 4.2 The installation of this pr duct will not require a n ricane protection s)slem. 5. LABELING 5.1 Each unit shall bear a pert-mine _ e manufacturer's name or logo, city, state and following, statement: "Miami -Dade County Product Control Approved ". 6. BUILDING PERMIT REQUIREMENTS 6.1 Application. for building permit shall be accompanied by copies of the fo lowing: 6.1.1 This Notice of Acceptance 6.1.2 Duplicate copies of the approved drawings, as identified in Section 2 of this Notice of Acceptance, clearly marked to show the components selected for he proposed installation. 6.1.3 Any other documents required by the I3uiiding Official or the South Florida 13uilding Code (SFBC) in order to properly evaluate the installation of this system. Raul Rodriguez, Chief Product Conirol Division 1. Renewal of this Acceptance (approval) shall be considered alter a renewal application has been filed and the original submitted documentation, including test supporting data, engineering docutnentS, are no older than eight (8) years. 2. Any and n1I approved products shall be permanently labeled with the mantilacturer's name, city. stale, and the following statement: "Miami -Dade County Product Control Approved ", or as specifically stated in the specific conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if: a) There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes: b) The product is no longer the same product (identical) as the one originally approved; c) If the Acceptance holder has not complied with all the requirements of this acceptance, including the correct installation of the product; d) The engineer who prepared, signed and sealed the required documentation istitia]Iy submitted is no longer practicing the engineering profession. 4. Any revision or change in the materials. use, and /or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior wr teen approval has been requested (through the filing ol' revision application with appropriate fee) and granted by this office. 5. Any of the following shall also he grounds for removal of this Acceptance: a) Unsatisfactory periormance of this product or process. h) Misuse of this Acceptance as an endorsement orally product, for sales. advertising or any ether purpose. 6. The Notice of Acceptance number preceded by the words Miami-Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is displayed, then it shall be done in its entirety. 7. A copy of this Acceptance as well as approved drawings and other documents, where it applies. shall be provided to the user by the manufacturer or its distributors and shall he .mailable for inspection at the job site at all time. The engineer need not reseal the copies. 8. Failure to comply with any section of this Acceptance shall he cause for termination and removal of Acceptance. This. Notice of Acceptance consists of pages I. 2 and this last page 3. I?NI) OF THIS ACCEPTANCE ,_ r c). PGT Industries. ACCEPTANCE No.: 01- 1108.07 APPROVED: December 27, 2001 EXPIRES: January 28, 2007 NOTICE 01 ACCEPTANCE: '1'ANCE: STANDAIti) CONDITiONS 3 Raul Rodrioucz, Chief Product Control Division M I A M I.DADE gME PRODUCT CONTROL NOTICE OF ACCEP•1':ti.NCE J'( ;•1' Industries 1070 •1'cchno101. ' Drive Nokomis ,F1., 34275 Your application Aluminium C. under Chaple Construction, : County Building, Co( 01 scillct 8 of the Code t icot pletcl d tan \(NOA) o1': it \\' ndo\1' imp: ct ( oc e o1 Mho County �,overnin�g the use of Alternate N 1:uerials and 'Types of n r)bcd herein, has been recommended for acceptance by the Miami-Dade e ompliance Office f13C'CO) under the conditions specified herein. This NOA shall not be valid alter the expiration date stated below. 13CCO reser,'es the right to secure this product or material at any time front a jobsite or manufacturer's plant for quality control testing. I1' this product or material fails to perform in the approved manner, I3CCO may revoke, modify, or suspend the use of such product or material immediately. 13CCU reserves the right to revoke this apl)rula!, if it is determined by 13CC0 that this product or material fails to meet the requircm:nts of the South Florida f3uildini Codc. •fhe expense of such testing 1vi11 be incurred by the manufacturer. 1i!acturer. ACCEPTANCE NO. 01-1108,07 EXPIRES: 01/2S/2007 APPROVED: 12/27/2001 ? 11.-17% 1-1),A1)1: COUNTY, FLORIDA it;'1'itO•D, \UL• FLT \GLI:1■ BUILDING lJl'll,l)l.N(; ('O1)1.: CO. \Il'L1:1.. \('I: (I :I('I.: 11:1 I) :11)1:l:1,:1(il 1:J' Ill :II.I)1''(i I•IU 11 !'I,.\(il! {1( til1(I!'t'. \IiI'iI Ir:Oi ;\II: \ \1I.1:1.U1(Ii):\ 33!31).i 54,3 (.1 )5) 375.29o1 29u1 l : \\ 00)37.S ('U.''1'ItArI'( >It (.ii)5)375.2%h I', \N (.1113) 17 Raul Rc'dri',uer ('hies l'rodticl Control Division THIS IS TIII: COVERSIIEET, SEE ADDITIONAL, PAGES FOR SPECIFIC AND GENT :It :t1, C()NI)I1'I0NS BUILDING CODE & PRODUCT RE \'IL; \V COMMITTEE This application Ibr Product Approval has been reviewed by the I3CCO and approved by the Budding Code and Product Review Committee to be used in Nliami -Dade County, Florida under the conditions set forth above. CO.V1'lt.WTOlt I.I('1:N'C1.\(; SECTION 005)113-25r FAX t►u l 37:.2;:g 1'1101)14T ('O \'1'I t O I . I )1 \' I S 1 O (1(l.+ )73 - ?' i2 1'.1\ (105) ,172- Francise.) J. Quini:uia, R.A. Director ' lionii•I•)i(le County 13uilding Code Compliance O!lice 1 \ 10 acceptance cover page.dot 1niernct mail address: p( lstmastcr .rr°buildin„codeonline.coln Z 1 1•o(tttjaige: 11Itp:// 1P1s \s.linild(n);cod('uuline.coul PG'I' Industries. ACCEPTANCE No.: 01- 1105.07 APPR0'ED: December 27, 2001 EXPIRES: January 28, 2007 NOTICE OF ACCEPTANCE: SPECIFIC CONDITIONS 1. SCOPE 1.1 This revises and renews Notice of Acceptance (NOA) No. 00 -0804.03, which was issued on December 7, 2000. It revises and renews the approval of an aluminum casement window, as described in Section 2 of this NOA, designed lo comply with the South Florida Building Cade (SPBC), 1994 Edition for Miami -Dade County, fir the locations where the pressure requirements, as determined by SFI3C Chapter 23, do not exceed the Design Pressure Rating values indicated in the approved drawings. 2. PRODUCT DESCRIPTION 2.1 The Series "C -700" Outswing Aluminum Casement Window — Impact Resistant and its components shall be constructed in strict compliance with the following document: Drawing No 339, Sheets 1 through 5 of 5, titled "Aluminum Casement Impact Window," prepared by manufacturer, dated 2/13/98 and revised on 11/6/01, signed and sealed by Robert L. Clark, P.L., bearing the Miami -Dadc County Product Control approval stamp with the NOA number and approval date by the Miami -Dade County Product Control Division. This document shall hereinafter be referred to as the approved drawings. 3. LIMITATIONS 3.1 This approval applies to single unit applications only, as shown in approved drawings. 4. INSTALLATION 4.1 The aluminum casement r dotic alt 11 onents shall be installed in strict compliance with the approved drawings. -1.2 The installation of thi product will not require a h,rricane protection system. S. LABELING 5.1 Each unit shall bear a permanent labe with the manufacturer's name or logo, city, state and following statement: "Miami -Dade County Product Control Approved ". 6. BUILDING PERMIT REQUIREMENTS 6.1 Application. for building permit shall be accompanied by copies attic fo lowing: 6.1.1 This Notice of Acceptance 6.1.2 Duplicate copies of the approved drawings, as identified in Section 2 of this Notice of Acceptance, clearly marked to show the components selected for he proposed installation. 6.1.3 Any other documents required by the 13uilding Official or the South Florida Building Code (SFI3C) in order to properly evaluate the installation of this system. Raul Rodriguez, Chief Product Control Division PGT Indostrics. Renewal of this Acceptance (approval) shall be considered alter a renewal aJ)l)Jlcation has been tiled and the original submitted documentation, including test supporting data, engineering documents, are no older than eight (i) years. 2. Any and all approved products shall he permanently labeled \vith the r, lanul;iclurcr's name, city. st :31c, and the lotlowing statement: "ivtiami -Dade County Product Control Approved", or as specifically slated in the specific conditions of this Acceptance. 3. Renewals of Acceptance will not be considered if: :3) There has been a change in the South Florida Building Code affecting the evaluation of this product and the product is not in compliance with the code changes; b) The product is no longer the same product (identical) as the one originally approved; c) If the Acceptance holder has not complied with all the requirements of this acceptance, including the correct installation of the product; d) The engineer who orio,inally prepared, signed and staled the required documentation initially submitted is no longer practicing the engineering profession. 4. Any revision or change in the materials. use, and /or manufacture of the product or process shall automatically be cause for termination of this Acceptance, unless prior wr teen approval has been requested (through the tiling of revision application with appropriate fee) and granted by this office. 5. i\ny of the following Shall also be grounds for removal of this Acceptance: a) Unsatislactory performance of this product or process. b) Misuse of this Acceptance as an endorsement ()limy product, for sales. advertising, or any other purpose. G. The Notice oC Acceptance number preceded by the words Miami -Dade County, Florida, and followed by the expiration date may be displayed in advertising literature. Ifany portion of the Notice of Acceptance is displayed, then it shall be done to its entirety. 7. A copy of this Acceptance as well as approved drawings and other documents. where it applies. shall be provided to the user by the manufacturer or its dislrihutors and shall he .mailable !iv inspection at the job site at all time. The engineer need not reseal the copies. 8. Failure to comply with any section of this Acceptance shall he cause for termination and removal of Acccpiance. "his. Notice ol'Acceptance consists ol'pages 1. 2 and this last page 3. ENI) OF TI IS ACCEPTANCE 9. NOl'1CI' OF STANDARD CONDITIONS 3 ACCEPTANCE No.: 01- 1105.07 APPROVED: December 27, 2001 EXPIRES: Jammu 28, 2007 Raul Rodriguez, Chief Product Control Division Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2002 -884 Printed: 5/7/2002 Applicant: MARIELENA Owner: GADOL JOB ADDRESS: 379 NE 100 Contractor ALL STATE WINDOWS DOORS & SHUTTERContractor's Address: 5205 NW 72 ND AVE Local Phone: 305 - 513 - 3388 Parcel # 1132060135390 Legal Description: Fees: FEE2002 -2573 FEE2002 -2574 FEE2002 -2580 Description Building Fee CCF Buildier's Bond Total Fees: Permit Status: Approved Permit Expiration: 11/3/2002 ork: INSTALL 6 SINGLE HUNG WINDOWS & 1 CASEMENT WINDOW If re is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. e is 0.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the buil ordinances pertaining thereto and with the understanding that the work will be perform and approved by the proper municipal authorities. This Permit may be revoked at any authorization. A further condition upon which this permit is granted is the understandir ordinances and regulations pertaining to the work covered hereby whether shown on ti by his agents. servants or employees. Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work coy' with the plans, drawings, statements or specifications submitted to the proper authoritie myself, my agent, servants or employes. Signed: (Contractor or Bulk Building Permit GADOL MARIELENA ST MIAMI SHORES SEC 1 AMD PB 10 -70 E1/2 LOT 21 & LOT 22 BLK 39 LOT SIZE Amount $112.50 $3.00 $300.00 $415.50 Construction Value: SAUL GADOL MARIELENA GADOL 379 NE 100TH ST MIAMI, FL 3313$ -2420 PAY TO THE ORDER OF $2,100.00 LL-6 G;R- F 4i _&L RES $ L4ISeo Lao L1 L; LLARS Merrill Lynch B ANK ONE. COLIA.ABUS. NA BANK = ONE. our„ (L-.D f IJC' MEMO Page 1 of 1 Total Fees: $415.50 Total Receipts: $0.00 Re- inspection r • r �/�, 5153 ?#V Cash Management Account DATE A ('R1L1 rcr��� C 25- 80/440 Permit No ... Disapproved (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT • Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build. ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address '53 Pr6 Registered Architect and /or Engineer ,,:,.. . ,,, „ ..... Name and address of licensed contractor cd 1, d P/1( 1 .. "A ,' Location and legal description of lot to be built on: -73 z ' 5:0-a 45” v'r /y-# i Lot Block y Subdivi _ Street and Number where work is to be done ... t. . lyy��� °�.�� _...._..�_ State work to be done and purpose of building (by floors) ... �� e e -,e „w-Ar 2� 7 '�'ra. __ 7w `i .. ......... .2..^✓f�G /tax . and for no other purpose. New Building Remodeling F,/ Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering aee Estimated Total cost of improvements $....0©� — Amount of Permit SQL/ Zone cubage required _Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work t b, performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) _.. Building Inspector Date..._........ �...._ / 3 _._.... No.. 7 ..._... Streettle i..... 4® mod , STATE OF FLORIDA, COUNTY OF DADE. j ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Date. _.. s ead, S •rn to and Subscribed before me. 643/4 Not ublic, S ate of Florida My Commission Expires fifaLr,."..11i; :.:.... 2.:` ..e ... .. BOi,DOD T!' � ' ' y. ,i PLANNING BOARD DATE MY CO IS; i,. . • , : S _ • 2 7 Chairman Member Member Member Member _....__..._......_ Member Council Approved. Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application nfter approval has been obtained from the Planning Board. A re- in.pcc•tion fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection at faulty materials and/or workmanship. 1r'pr